Attachment 3 CCN Next Generation Medical West Price Schedule v2.xlsx
XLSX spreadsheet 37 KB Posted
- Attached to
- Q201--CCN-Next Gen Medical
- Solicitation number
- 36C10G26R0003
About this file
This is a Pricing Template for the Community Care Network (CCN) Next Generation Medical West contract opportunity. The template establishes a comprehensive pricing structure across multiple Contract Line Item Numbers (CLINs) spanning a six-year period (Base Year plus five option years) for healthcare services delivery to veterans.
Core pricing CLINs include: Standard Medicare Rate healthcare services (CLIN X001AA) up to 100% of Medicare reimbursement; PPS Exempt healthcare services (CLIN X001AB) at CMS PPS Exempt rates; Waivers of Payment Rates (CLIN X002) with maximum percentages above Medicare or VA Fee Schedule; Seasonal Vaccinations (CLIN X003) at a per-vaccination rate; VA Fee Schedule services (CLIN X004AA) and Alaska Fee Schedule services (CLIN X004AB) at respective applicable rates; Non-Medicare, Non-VA, Non-Alaska Fee Schedule services (CLIN X005) at 50% of billed charges; and Organ Acquisition Costs (CLIN X009) up to 100% Medicare per CMS D-4 Worksheet. Additional CLINs address Urgent and Emergent Medications (CLINs X006 and X007 for disaster response) priced as percentages of Average Selling Price (ASP) for brand and generic medications plus per-unit dispensing fees; Administrative Services (CLIN X008) for healthcare and pharmacy benefits management scaled to monthly enrolled veteran population; Implementation (CLIN X011) and Transition Out (CLIN X012) services priced as fixed lump sums; and optional services including Healthcare Appointment Scheduling and Comprehensive Care Coordination (CLIN X014) with five tiered pricing levels, Care Coordination Follow-Up (CLIN X015), and Software Development (CLIN X016) with five task-size categories. Offerors must provide Bases of Estimate (BOE) documentation for multiple CLINs, establishing detailed cost justification for their proposed pricing across all service categories.
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Text version
Pricing Template
| Community Care Network Next Generation - Medical West |
| Pricing Schedule |
| Offeror Name: | ||||||||
| Prices per CLIN per year | Base Period | Option Period | Option Period | Option to Extend Services | ||||
| CLIN | DESCRIPTION | UNIT | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | Year 6 |
| CLIN X001 | Healthcare Services | |||||||
| CLIN X001AA | Standard Medicare Rate Healthcare Services | Up to 100% Medicare | ||||||
| CLIN X001AB | PPS Exempt Healthcare Services | Up to CMS PPS Exempt Rate | ||||||
| CLIN X002 | Waivers of Payment Rates | Maximum % above Medicare or VA Fee Schedule Rate | ||||||
| CLIN X003 | Seasonal Vaccinations | $ per vaccination | ||||||
| CLIN X004 | Fee Schedule | |||||||
| CLIN X004AA | VA Fee Schedule | Up to VA Fee Schedule | ||||||
| CLIN X004AB | Alaska Fee Schedule | Up to Alaska Fee Schedule | ||||||
| CLIN X005 | Non-Medicare, Non-VA, Non-Alaska Fee Schedule Healthcare Services | 50% billed charges | ||||||
| CLIN X006 | Urgent and Emergent Medication | |||||||
| CLIN X006AA | Brand Name Medication | % of ASP per medication | ||||||
| CLIN X006AB | Generic Medication | % of ASP per medication | ||||||
| CLIN X006AC | Dispensing Fee | $ per medication dispensed | ||||||
| CLIN X007 | Disaster Response: Urgent and Emergent Medication | |||||||
| CLIN X007AA | Brand Name Medication | % of ASP per medication | ||||||
| CLIN X007AB | Generic Medication | % of ASP per medication | ||||||
| CLIN X007AC | Dispensing Fee | $ per medication dispensed | ||||||
| CLIN X008 | Administrative Services | |||||||
| CLIN X008AA | Administrative Services for Healthcare Services | Monthly Enrolled Veteran Population | ||||||
| CLIN X008AB | Administrative Services for Pharmacy Benefits Management (PBM) | Monthly Enrolled Veteran Population | ||||||
| CLIN X009 | Organ Acquisition Cost | Up to 100% Medicare per CMS D-4 Worksheet | ||||||
| CLIN X010 | Incentives/Disincentives | |||||||
| CLIN X010AA | Adverse Credit Reporting Incentives | % incentive/disincentive | ||||||
| CLIN X010AB | Value Based Care Lower Extremity Joint Replacement (LEJR) Performance Incentive | % incentive/disincentive | ||||||
| CLIN X011 | Implementation | Fixed Price Lump Sum | ||||||
| CLIN X012 | Transition Out | Fixed Price Lump Sum | ||||||
| CLIN X013 | Optional Task Implementation | |||||||
| CLIN X013AA | Implementation for Appointment Scheduling and Comprehensive Care Coordination at the VA Facility | $ total cost of implementation per VA Facility | ||||||
| CLIN X013AB | Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor's Site | $ total cost of implementation at Contractor’s site | ||||||
| CLIN X014 | Optional: Healthcare Appointment Scheduling and Comprehensive Care Coordination | |||||||
| CLIN X014AA | Appointment Scheduling Administration and Comprehensive Care Coordination Tier 1 | $ per Approved Referral for Appointment Scheduling | ||||||
| CLIN X014AB | Appointment Scheduling Administration and Comprehensive Care Coordination Tier 2 | $ per Approved Referral for Appointment Scheduling | ||||||
| CLIN X014AC | Appointment Scheduling Administration and Comprehensive Care Coordination Tier 3 | $ per Approved Referral for Appointment Scheduling | ||||||
| CLIN X014AD | Appointment Scheduling Administration and Comprehensive Care Coordination Tier 4 | $ per Approved Referral for Appointment Scheduling | ||||||
| CLIN X014AE | Appointment Scheduling Administration and Comprehensive Care Coordination Tier 5 | $ per Approved Referral for Appointment Scheduling | ||||||
| CLIN X015 | Optional: Care Coordination Follow-Up | $ per Approved Referral for Care Coordination Follow-up | ||||||
| CLIN X016 | Optional: Software, Process, and Proof of Concept Development | |||||||
| CLIN X016AA | Extra-Small (XS) Software Development Task Size | $ per software development task | ||||||
| CLIN X016AB | Small Software Development Task Size | $ per software development task | ||||||
| CLIN X016AC | Medium Software Development Task Size | $ per software development task | ||||||
| CLIN X016AD | Large Software Development Task Size | $ per software development task | ||||||
| CLIN X016AE | Extra Large (XL) Software Development Task Size | $ per software development task |
CLIN X002 BOE
| CLIN X002 - Waivers of Payment Rates |
| BOE |
Offeror Name:
CLIN X003 BOE
| CLIN X003 - Seasonal Vaccinations |
| BOE |
Offeror Name:
CLIN X006 BOE
| CLIN X006 - Urgent and Emergent Medication |
| BOE |
Offeror Name:
CLIN X007 BOE
| CLIN X007 - Disaster Response ONLY: Urgent and Emergent Medication |
| BOE |
Offeror Name:
CLIN X008 BOE
| CLIN X008 - Administrative Services |
| BOE |
Offeror Name:
CLIN X011 BOE
| CLIN X011 - Implementation |
| BOE |
Offeror Name:
CLIN X012 BOE
| CLIN X012 - Transition Out |
| BOE |
Offeror Name:
CLIN X013 BOE
| CLIN X013 - Optional Task Impelmentation |
| BOE |
Offeror Name:
CLIN X014 BOE
| CLIN X014 - Optional: Healthcare Appointment Scheduling and Comprehensive Care Coordination |
| BOE |
Offeror Name:
CLIN X015 BOE
| CLIN X015 - Optional: Care Coordination Follow-Up |
| BOE |
Offeror Name:
CLIN X016 BOE
| CLIN X016 - Optional: Software Development |
| BOE |
Offeror Name:
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